Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.70 / $233.85 / $233.85	Facility	26	$89.70	$233.85	$233.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $214.90 / $342.37 / $356.54	Professional		$214.90	$342.37	$356.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.09 / $57.51 / $64.19	Professional	26	$47.09	$57.51	$64.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $167.82 / $287.81 / $299.02	Professional	TC	$167.82	$287.81	$299.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.09 / $48.15 / $110.46	Professional	26	$46.09	$48.15	$110.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $193.76 / $413.97 / $600.25	Professional		$193.76	$413.97	$600.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.58 / $123.02 / $173.97	Professional	26	$57.58	$123.02	$173.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.18 / $290.95 / $417.19	Professional	TC	$136.18	$290.95	$417.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.81 / $75.81 / $75.81	Facility	26	$75.81	$75.81	$75.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $267.26 / $476.64 / $875.24	Professional		$267.26	$476.64	$875.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.68 / $121.88 / $177.88	Professional	26	$73.68	$121.88	$177.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.24 / $340.23 / $741.95	Professional	TC	$190.24	$340.23	$741.95
Harvard Pilgrim Facility/Professional Professional Modifier Low / Median / High Price $221.81 / $394.20 / $730.66	Professional		$221.81	$394.20	$730.66
Harvard Pilgrim Facility/Professional Professional Modifier 26 Low / Median / High Price $65.91 / $117.14 / $217.11	Professional	26	$65.91	$117.14	$217.11
Harvard Pilgrim Facility/Professional Professional Modifier TC Low / Median / High Price $155.90 / $261.24 / $513.54	Professional	TC	$155.90	$261.24	$513.54
United Facility/Professional Professional Modifier Low / Median / High Price $288.58 / $360.72 / $644.12	Professional		$288.58	$360.72	$644.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.49 / $79.98 / $171.75	Professional	26	$62.49	$79.98	$171.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $175.22 / $254.07 / $556.41	Professional	TC	$175.22	$254.07	$556.41
Well Sense Facility/Professional Professional Modifier Low / Median / High Price $183.51 / $201.86 / $256.91	Professional		$183.51	$201.86	$256.91
Well Sense Facility/Professional Professional Modifier 26 Low / Median / High Price $48.14 / $53.34 / $58.19	Professional	26	$48.14	$53.34	$58.19
Well Sense Facility/Professional Professional Modifier TC Low / Median / High Price $134.05 / $148.52 / $162.02	Professional	TC	$134.05	$148.52	$162.02